NICE Scorecard needs to track more new drugs, says industry

The new Innovation Scorecard, looking at the use of NICE-recommended drugs and treatments by the NHS in England, has now been published, but it needs to cover many more new medicines if it to become a useful long-term tool, the industry has said.

The Scorecard is published by the NHS Health and Social Care Information Centre (HSCIC) and covers a total of 102 technology appraisals (TAs), consisting of 76 medicines and six medical technologies. In all, 52 medicines in 25 groups relating to 35 TAs were considered, out of which a comparison of predicted use with observed use was made for just 13 groups.

The report finds, that, during 2011, actual use in the NHS in England was higher than predicted for: the brain cancer treatment temozolomide; varenicline - an aid for smoking cessation; insulin glargine and detemir for type 1 diabetes; osteoporosis treatments (alendronate, etidronate, risedronate, raloxifene, strontium ranelate, teriparatide and denosumab); statins; and carmustine implants, used in the treatment of recurrent gliobalastoma multiform.

Use was lower than predicted for: acute coronary syndrome treatments (abciximab, eptifibatide and tirofiban); riluzole - used to extend life in patients with amyotrophic lateral sclerosis (ALS); naltrexone for recovering heroin addicts; trastuzumab for the treatment of advanced breast and gastric cancer; procalopride for chronic constipation in women; and febuxostat for chronic hyperuricaemia in gout.

For one medicine, ranibizumab, for the treatment of age-related macular degeneration, use was found to be higher when measured in milligrams but lower if measured in vials.

The report includes comparisons in the use of these treatment groups by NHS organisations where patient numbers were large enough to do so without risking identification, and these numbers suggest variation in their use across the country, says the Centre.

However, it points out that this regional variation could be due to a variety of factors, including gaps in data, differences in demography and disease prevalence across the data. Also, figures may be based on small numbers of patients for each of drugs it considered.

"Users of the figures should also remember that many of the medicines considered are only one of a number of treatment options available to clinicians. This means some variation in use should be expected, and may be due to the prescribing preferences of clinicians in local areas," says HSCIC chief executive Tim Straughan. "We are keen to encourage NHS organisations to look at this report and consider local medicines use in relation to the needs of the local population," he adds.

Mr Straughan also points out that the report continues to be badged as "experimental," because it relies on deriving estimates for the numbers of eligible patients and expected use of medicines. This requires a number of assumptions for things such as average length of time for treatments, which are extremely difficult to produce.

"Anyone interpreting the figures needs to be clear about the limitations of what the data show and it would certainly be wrong to think they definitely show drugs are being either 'user' or 'over' prescribed," he cautions.

However, it its response, the Association of the British Pharmaceutical Industry (ABPI) said that while the industry recognises that the Scorecard is experimental in nature, it needs to include many more new medicines in future if it is to become a useful, long-term tool.

"Worryingly though, of the new medicines measured against expected uptake, their usage is much lower than expected. This again appears to demonstrate the ongoing problems with getting the latest and most innovative medicines to NHS patients," the group adds.

"This first Scorecard is less detailed than ABPI had hoped for and we envisage future scorecards offering more details on how the NHS is complying with NICE guidance, but we welcome its publication as a first step on a transparency journey in the new NHS," said ABPI chief executive Stephen Whitehead.